Orange County health officials say they are “very concerned” about a possible hepatitis A outbreak, but unlike Los Angeles and San Diego counties, no outbreak has occurred locally.

The viral disease, which is preventable by vaccine, is caused by ingesting the feces of an infected person, usually because the person has not washed their hands properly after using the toilet. It can also be contracted through contaminated, uncooked food or sexual contact. Homeless people are at a high risk for infection because they live with poor sanitary conditions.

The county is continuing its standard practice of vaccinating homeless individuals and educating them about the outbreak, but has not adopted any special sanitation efforts.

“The best way to protect yourself is to get vaccinated, and vaccination efforts are our primary response effort now to prevent spread of hepatitis A in OC,” said county spokeswoman Carrie Braun.

Between 2011 and 2016 Orange County has reported 15 to 25 cases of hepatitis A each year. So far this year there have been 13 reported cases.

“So our numbers so far this year are not atypical compared with years past,” said Orange County Health Care Agency spokeswoman Jessica Good in an email. Even so, she said, county officials are “very concerned” about a possible outbreak.

Click to View: Hepatitis A Factsheet

Most cases of hepatitis A in Orange County are contracted after international travel or exposure to a known infected patient, according to a July 26 health advisory issued by the Health Care Agency.

Five infections reported since May 2017 occurred in adult men who had not traveled and were otherwise not exposed to the disease, according to the July advisory. Those cases also had no known exposure to homeless populations or illicit drug use, and no common source has been identified.

The Health Care Agency so far has vaccinated 368 homeless individuals with the hepatitis A vaccine, Good said.

According to the 2017 Point-in-Time count, a survey of homeless people on one given night a year, there are 4,792 homeless individuals living in Orange County.

“Generally, vaccinations are provided only in conjunction with a vaccination “clinic” or event and nurses do not carry vaccine with them,” Good said. “In the event of an outbreak in Orange County, additional approaches could be implemented.”

Good said the definition of an ‘outbreak’ can vary for the general population and specific groups of people.

“If two people in general population came down with virus, reported no travel, etc. that wouldn’t necessarily indicate an outbreak,” said Good in an email. “If two folks in same group of that population (individuals in homeless community, specific school, specific workplace, etc.) did, that would signal something different.”

Dr. Matthew Zahn, medical director of epidemiology and assessment for the OC Health Care Agency, said the agency defines an outbreak within a specific population as two or more cases where the infected person has no history of travel or contract with other known outbreaks.

Los Angeles County health officials declared a hepatitis A outbreak Tuesday with 10 reported cases, following a major outbreak in San Diego County that has infected 444 people and killed 16.

According to the Los Angeles Times, two new hepatitis A cases involving homeless people were reported in LA County Tuesday, triggering the outbreak declaration. The two homeless people have not traveled to a place with an outbreak.

There are eight other infected patients, five who recently traveled to San Diego or Santa Cruz County, and three people who were infected at a hospital where one of those five people was being treated, the Times reported. Santa Cruz County also is experiencing an outbreak.

Earlier this month, San Diego county health officials declared a public health emergency due to the hepatitis A outbreak.

The San Diego outbreak has largely affected homeless people and illicit drug users, in part due to poor sanitation and a lack of public restrooms available to homeless individuals, causing many to relieve themselves on public sidewalks and streets.

San Diego city officials recently installed 40 handwashing stations and dozens of portable toilets citywide to combat the outbreak.

In Los Angeles, officials have begun power-washing streets and sidewalks in Skid Row areas with a bleach solution.

Advocates for the homeless in Orange County have called on the county to place portable toilets and hand wash stations near major homeless encampments, where many people are forced to urinate and defecate into plastic bags and buckets.

After county supervisors declined requests to place restrooms along the Santa Ana River, advocates raised money on their own and purchased three porta-potties, which they placed along the riverbed until county officials ordered them removed due to lack of a permit.

A head count this summer by City Net, a nonprofit contracted with the county to provide homeless outreach services, determined 422 homeless people live along the riverbed near Angel Stadium.

Earlier this month, the Anaheim City Council considered a plan to allow the portable toilets to be placed on city property along the river bed, but took no action.

Braun noted that one public restroom located near the Santa Ana River trail, which used to be closed at night, is now open 24 hours a day and is cleaned and maintained by the county.

Contact Thy Vo at or follow her on Twitter @thyanhvo. 

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